| NPI | 1316938160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology (Licence: NM MD2022-1352) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 12726) |
| 207Y00000X Otolaryngology (Licence: PA MD064495L) | |
| 207Y00000X Otolaryngology (Licence: TX P3319) | |
| Enumeration Date | 2005-11-01 |
| Last Update Date | 2022-11-15 |